OVERVIEW OF ICCAM: PRINCIPLES, ASSESSMENTS AND IMAGING PARADIGMS.

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Lingford-Hughes A1, Paterson L1, McGonigle J1, Flechais1, Elliott R2, Ersche KD3,4, Murphy A2, Orban C1, Smith D3,5, Suckling J3,4, Taylor E2, Robbins TW3,5, Deakin JWF2, Nutt D1, ICCAM consortium.
1Centre for Neuropsychopharmacology, Division of Brain Sciences, Imperial College, London UK 
2Neuroscience and Psychiatry Unit, Institute of Brain Behaviour and Mental Health, University of Manchester, Manchester, UK
3Behavioural and Clinical Neuroscience Institute, University of Cambridge, UK 4Department of Psychiatry, University of Cambridge, UK
5Department of Psychology, University of Cambridge, UK
Drug and alcohol dependence are global problems with substantial societal costs. There are few treatments for relapse prevention and therefore a pressing need for further study of brain mechanisms underpinning relapse circuitry. The Imperial College Cambridge Manchester (ICCAM) platform study is an experimental medicine approach to this problem: using functional magnetic resonance imaging (fMRI) techniques and selective pharmacological tools, it aims to explore the neuropharmacology of putative relapse pathways in cocaine, alcohol, opiate dependent, and healthy individuals to inform future drug development. Addiction studies typically involve small samples because of recruitment difficulties and attrition. We established the platform in three centres to assess the feasibility of a multisite approach to address these issues. Pharmacological modulation of reward, impulsivity and emotional reactivity were investigated in a monetary incentive delay task, an inhibitory control task, and an evocative images task, using selective antagonists for μ-opioid, dopamine D3 receptor (DRD3) and neurokinin 1 (NK1) receptors (naltrexone, GSK598809, vofopitant/aprepitant), in a placebo-controlled, randomised, crossover design. In two years, 609 scans were performed, with 155 individuals scanned at baseline. Attrition was low and the majority of individuals were sufficiently motivated to complete all five sessions (n=87). This talk will describe the study design, main aims, recruitment numbers, sample characteristics, and the main hypotheses. The remaining talks in this symposium will describe modulation of some of the tasks by each of the pharmacological modulators in the patient groups.

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